Abstract

«Therapy aimed at reversing the persistent vegetative state has not been successful» [2]. This is one conclusion of the report of the Multi-Society Task Force on PVS, which examined the medical aspects of the persistent vegetative state (PVS). Although controversial, stimulation interventions for patients in PVS after an acute brain injury are an element of clinical practice in many countries, both for ethical and for scientific reasons, until enough knowledge is accumulated on this clinical entity. Present methods of treatment and their scientific rationale, expected levels of improvement in consciousness due to treatments and research methodologies for outcome studies appropriate for this rare and very variable clinical condition are not well known in the scientific literature. As Cope [4] mentioned in his analysis of the effectiveness of traumatic brain injury(TBI)rehabilitation in general, there is a large number of «outcome studies» ofTBIrehabilitation but the vast majority of these do little to help resolve the issue of efficacy, as they fail to address issues of pre-and post-treatment function, spontaneous recovery, definition of severity of injury and other methodological problems. This is particularly true for the stimulation programs for patients in PVS. Analysis of existing scientific publications on the efficacy of these interventions is required to disentangle the present situation in which clinicians feel the necessity to do something for their patients but are restrained by conflicting opinions in the literature and the resulting disinterest of researchers. A non-wanted effect of the absence of critical studies is a drastic change in hospital policy, resulting in the interruption of stimulation interventions without and before a demonstration of their efficacy/inefficacy. To bring additional light to this complex clinical situation, this paper critically reviews scientific publications addressing the clinical efficacy of stimulation interventions for patients in coma or in vegetative state.